We present the case histories of five patients with Erdheim-Chester disease, a rare lipoidosis that has several typical radiographic features. In all the patients, the diaphyses and metaphyses of the extremities demonstrated a symmetric pattern of diffuse or patchy increased density, a coarsened trabecular pattern, medullary sclerosis, and cortical thickening. The epiphyses were spared in four patients and partially involved in one. The axial skeleton was involved in one patient. Radiotracer 99mTc accumulated in areas of radiographic abnormalities in all patients. In one patient, MRI demonstrated an abnormal signal, corresponding to radiographic abnormalities. The signal was hypointense to muscle on T1-weighted sequences and heterogeneously hyperintense and hypointense to normal bone marrow on T2-weighted sequences. Xanthogranulomatous lesions infiltrated the retroperitoneum in one patient, the testes in one patient, the eyelids in one patient, and the orbits in two patients.

Aged↗

PubMed1998

Granuloma annulare: radiographic demonstration of progressive mutilating arthropathy with vanishing bones.

Granuloma annulare, a relatively common cutaneous disorder of unknown origin, is named for its predominantly papular lesions, which tend to group and coalesce in an annular fashion. Clinically distinct subtypes are divided into localized, generalized, perforating, and subcutaneous forms. Only the superficial granulomata of the extremities in subcutaneous granuloma annulare have been radiographically depicted in the literature. We describe and illustrate what we believe is the first radiographic presentation of bone and joint involvement with advanced, generalized granuloma annulare.

Aged↗

PubMed1997

Imaging of articular pathology: MRI, CT, arthrography.

The purpose of this review article is to present the advantages and limitations of magnetic resonance imaging (MRI), computed tomography (CT) and arthrography for evaluating articular pathology. Techniques, patient selection, indications and contraindications for each modality are reviewed. MRI provides superior soft tissue contrast and image plane selection, making it the ideal technique for most articular abnormalities. However, obese patients and patients with certain electrical or metallic implants cannot be examined with MRI. CT provides superior detail for fine cortical bone and subtle calcifications, but lacks the soft tissue contrast provided by MRI. Arthrography is an invasive technique with minimal risk of allergy to contrast material or infection. This technique permits accurate measurement of capsular volume, allows for fluid aspiration for laboratory studies and permits injection of anesthetic and/or steroid compounds for purposes of treatment or confirming the site of the patient's pain. Magnetic resonance imaging, computed tomography and arthrography are useful techniques for evaluating articular pathology. Careful review of the clinical symptoms and patient's condition is necessary to select the most appropriate technique.

Arthrography↗

PubMed1997

Imaging of the spine. Techniques of MR imaging.

Recently, magnetic resonance (MR) imaging has become the preferred method of evaluation for spinal disorders. The vertebrae, intervertebral disks, ligaments, spinal canal, and neural foramen may all be evaluated using current MR imaging techniques. MR imaging with paramagnetic contrast has developed into a valuable technique for diagnosing a tumor, an infection, or a degenerative disease. Computed tomography remains the procedure of choice for examining fine cortical bone detail including evaluation of spine fractures and assessing neural foraminal size, but it is not sensitive for detecting marrow-infiltrating disorders.

Cervical Vertebrae↗

PubMed1997

Imaging of tendon injuries about the ankle.

Explore the source record for details and available documents.

Ankle Injuries↗

PubMed1995

MR imaging techniques for soft-tissue lesions.

MR imaging is the technique of choice for detection, characterization, and staging of soft-tissue neoplasms. MR examinations need to be tailored to each patient based upon the patient's size and anatomic region of interest so that optimal information is obtained. Technique is critical. Proper positioning to allow patient comfort and reduce motion artifacts is essential. Selection of the appropriate coils, image planes, and optimal pulse sequences to identify and determine the extent of lesions is critical for therapy planning.

Artifacts↗

PubMed1994

Magnetic resonance imaging of the anterior radiocarpal ligaments.

Magnetic resonance imaging was applied to eight cadaver wrists to evaluate the efficacy of imaging the anterior radiocarpal ligaments. In order to verify a correlation between the magnetic resonance images and anatomic structures, ancillary studies using gadolinium-DTPA ligamentography and gross sectioning of the specimens were performed. The ligaments targeted for evaluation were the radioscaphocapitate, long radiolunate, and short radiolunate ligaments. The highest resolution images were obtained using a 1.5 Tesla magnetic resonance imaging scanner and a surface coil applied to the wrist region, and producing T1-weighted images, with 3 mm thick sections with an 8 cm field of view. The radioscaphocapitate, long radiolunate, and short radiolunate ligaments were most consistently identified in sagittal planes, however they were also identified in coronal planes. The radioscapholunate ligament and the interosseous ligaments between the scaphoid, lunate, and triquetrum were most consistently identified in coronal planes. Transaxial planes provided consistently inferior views, and should be reserved for imaging of the flexor and extensor retinaculae.

Adult↗

PubMed1994

ASA monitoring standards and magnetic resonance imaging.

Some patients, often because of age or altered mental state, require general anesthesia or monitored anesthesia care and sedation if adequate magnetic resonance imaging (MRI) is to be accomplished. This study evaluated whether patients can be monitored during MRI with 1.5-tesla scanners in a manner which complies with ASA monitoring standards without causing degradation of image quality. Ten volunteers were scanned in the MRI without sedation. Monitors meeting ASA standards were placed and electronic artifact produced by the magnetic resonance (MR) scanner was evaluated, after which two scans of the head and two of the chest were performed. One of each pair of scans was obtained with the monitors functioning and one with them turned off. Four radiologists, blinded as to whether the monitors were turned on or off, independently evaluated the 20 pairs of scans. Differences in diagnostic quality and image degradation between the scans were evaluated and scores assigned. All monitors functioned appropriately during the scans, with the exception of the electrocardiogram (ECG) which was grossly distorted to the extent that only ventricular rate could be evaluated. None of the head or body scans was nondiagnostic; however, images with the monitors off were of better quality overall than with them on. Two types of noise were generated and are described. During the head scans, three of seven monitoring combinations caused degradation of the images, while four were judged clinically adequate. During the body scans, two of six monitoring combinations created noticeable noise, while four introduced no significant noise. Ungated cardiac scans were nondiagnostic.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗

PubMed1993

A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments.

OBJECTIVE: To determine: 1) whether a simple clinical prediction rule could identify emergency department patients with ureteral calculi; 2) whether the kidney, ureter, and bladder (KUB) radiograph provides diagnostic information beyond that obtained from the history and physical examination; and 3) whether ureteral calculi can be diagnosed accurately in the emergency department without emergency excretory urography, commonly known as intravenous pyelography (IVP). PATIENTS: Two hundred three patients who underwent emergency KUB and IVP studies for nontraumatic abdominal or flank pain (derivation group) were retrospectively identified from radiology department records; 72 patients were prospectively evaluated in the emergency department for suspected ureteral stones (validation group). MEASUREMENTS: Clinical information included age, gender, characteristics of pain, associated symptoms, presence of fever, history of ureteral calculi, whether a stone was passed, and results of urinalysis and KUB and IVP studies. All KUB and IVP radiographs were independently reviewed by a radiologist blinded to the patient's clinical information and urinalysis results. DESIGN: Stepwise linear discriminant analysis was used to derive a four-item prediction rule from the derivation group and the validation group; the areas under the receiver operating characteristic (ROC) curves and the misclassification rates were compared. RESULTS: The four-item rule (acute onset, flank pain, hematuria, and positive KUB radiograph) correctly classified 83% of patients in the derivation group and 90% in the validation group. The four-item rule had an ROC area of 0.86 in the derivation group and 0.89 in the validation group. The KUB radiograph significantly improved the discriminant ability of the two history items and the urinalysis result. Thirty-three percent of patients were identified to be in a subset with a 96% probability of having a stone. CONCLUSION: These findings, which should be confirmed in another emergency department, suggest that subsets of patients with suspected ureteral calculi may be managed without emergency IVP; this approach thereby reduces the time a patient spends in the emergency department, radiation exposure, expense, and morbidity.

Adolescent↗

PubMed1993

Magnetic resonance imaging of primary skeletal neoplasms.

The primary role of magnetic resonance (MR) imaging of skeletal neoplasms is that of staging. Understanding the staging process and selection of the proper imaging planes and pulse sequences is essential for proper staging. To date, image features are not specific for histologic type. In addition, there are still pitfalls with MR imaging for evaluating recurrent tumor or following therapeutic response to treatment. Dynamic gadolinium studies and spectroscopy may improve the future overall specificity for MR imaging.

Bone Neoplasms↗